News You Can Use

These Practice Guidelines (Am Fam Phys, Aug) make the following key points: Treatment of stage A heart failure should focus on reducing modifiable risk factors, including management of hypertension and hyperlipidemia; To prevent symptomatic heart failure, ACE inhibitors and beta blockers hould be used in all patients with stage B or C heart failure who have a reduced ejection fraction; Patients with stage C heart failure and fluid retention should be treated with diuretics in addition to ACE inhibitors and beta blockers. Click here to read full text.

This Sept. “in press” article, (NEJM) concludes “these data indicate that without drastic improvements in control measures, the numbers of cases of and deaths from ebola virus disease are expected to continue increasing from hundreds to thousands per week in the coming months.” Click here to read full-text.

“This system misses all of the intangible factors that help gauge the quality and efficiency of the care being delivered. It focuses physicians on the wrong goals for promoting health, such as how well they code chart to capture higher-value “units”. The Advisory Board Company, a health-care consulting firm, estimates that when hospitals last went on a physician-acquisition binge in the late 1990s, productivity fell as much as 35%.” (WSJ Mar 2013) Click here to read full text.

Article concludes: The high rate of E-cigarette use observed is consistent with recent articles highlighting increased E-cigarette us in the general population. The current longitudinal findings raise doubts concerning the usefulness of E-cigarettes for facilitating smoking cessation among patients with cancer. Cancer, Sept, 2014 online early pub) Click here to read full-text.

This Medscape article deals with many of the problems that physicians have in regard to getting organized. An oft-heard comments is, “We let them do this to us, we gave away our power. If we want to change medicine in a different way, we have to work together to take it back.” But can – or will – that ever happen? This article reviews the options. Click here to read full-text.

The American Geriatrics Society Position Statement statement: 1. Feeding tubes are not recommended for older adults with advanced dementia. Careful hand feeding should be offered; for persons with advanced dementia, hand feeding is at least as good as tube feeding for the outcomes of death, aspiration penumonia, functional status, and comfort. Tube feeding is associated with agitation, greater use of physical and chemical restraints, greater healthcare use due to tube-related complications, the development of new pressure ulcers. 2. Efforts to enhance oral feeding by altering the environment and creating individual-centered approaches to feeding should be part of usual care for older adults with advanced dementia. 3. Tube feeding is meedical therapy that an individual’s surrogat3e decision-maker can decline or accept in accordance with advance directives, previously stated wishes, or what it is thought the individual would want. 4. It is the responsibility of all members of the healthcare team caring for residents in long-term care settings to understand any previously expressed wishes of the individual (through review of advance directives and with surrogate caregivers) regarding tube feeding and incoproarte these wishes into the care plan. (JAGS, Aug) Click here to read full text.

This updated review (Lancet, March) summarizes the epidemiology, causes, pathophysiology, diagnosis, assessment and workup, non-pharmacological prevention and treatment, pharmacological prevention and treatment, controversies and future directions with recommendations. “Delirium is an acute disorder of attention and cognition in elderly peiople that is common, serious, costly, under-recognised, and often fatal. A formal cognitive assessment and history of acute onset of symptoms are necessary for diagnosis. In view of the complex multifactorial causes of delirium, multicomponent pharacological approaches are recommended.” Click here to read full-text.